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Hawkins AT, Penson DF, Geiger TM, Bonnet KR, Mutch MG, Maguire LH, Schlundt DG, Rothman RL. The Patient Perspective on Colectomy for Recurrent Diverticulitis: A Qualitative Study. Ann Surg 2024; 279:818-824. [PMID: 38318711 PMCID: PMC10997445 DOI: 10.1097/sla.0000000000006225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Understand the patient's decision-making process regarding colectomy for recurrent diverticulitis. BACKGROUND The decision to pursue elective colectomy for recurrent diverticulitis is highly preference-sensitive. Little is known about the patient's perspective in this decision-making process. METHODS We performed a qualitative study utilizing focus groups of patients with recurrent diverticulitis at 3 centers across the United States. Using an iterative inductive/deductive approach, we developed a conceptual framework to capture the major themes identified in the coded data. RESULTS From March 2019 to July 2020, 39 patients were enrolled across 3 sites and participated in 6 focus groups. After coding the transcripts using a hierarchical coding system, a conceptual framework was developed. Major themes identified included participants' beliefs about surgery, such as normative beliefs (eg, subjective, value placed on surgery), control beliefs (eg, self-efficacy, stage of change), and anticipated outcomes (eg, expectations, anticipated regret); the role of behavioral management strategies (eg, fiber, eliminate bad habits); emotional experiences (eg, depression, embarrassment); current symptoms (eg, severity, timing); and quality of life (eg, cognitive load, psychosocial factors). Three sets of moderating factors influencing patient choice were identified: clinical history (eg, source of diagnosis, multiple surgeries), clinical protocols (eg, pre-op and post-op education), and provider-specific factors (eg, specialty, choice of surgeon). CONCLUSIONS Patients view the decision to undergo colectomy through 3 major themes: their beliefs about surgery, their psychosocial context, and moderating factors that influence participant choice to undergo surgery. This knowledge is essential both for clinicians counseling patients who are considering colectomy and for researchers studying the process to optimize care for recurrent diverticulitis.
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Affiliation(s)
- Alexander T Hawkins
- Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN
| | - Timothy M Geiger
- Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Matthew G Mutch
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Lilias H Maguire
- Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
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Carmona Agúndez M, Gallarín Salamanca IM, Salas Martínez J. Free perforation during the first episode of acute diverticulitis: can it be avoided? Updates Surg 2024; 76:521-528. [PMID: 38168842 DOI: 10.1007/s13304-023-01743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
The aims of the present study are to compare the severity of acute diverticulitis in the first episode and in later bouts, and to determine whether there are risk factors for the presence of free perforation at the onset of diverticulitis. A single-center retrospective study was conducted of patients who developed a first episode of acute diverticulitis between January 2011 and August 2021 diagnosed by computed tomography and followed up for at least 1 year. Free perforation was considered to be present in patients with diverticulitis stage III and IV according to the Hinchey classification (modified by Wasvary). The analysis included 394 patients (224 men and 170 women) with a mean age of 58 years. Forty-eight patients (12.2%) presented free perforation at some point in the course of the disease, 43 during the first episode and 5 during subsequent bouts. The perforation subgroup showed higher rates of stoma creation and mortality (relative risks of 12.3 and 23.5, respectively). In the multivariate analysis, age (OR: 1.041 95% CI 1.016-1.067), lung disease (OR 2.154 95% CI 1.038-4.472) and immunosuppression (OR: 2.812 95% CI 1.315-6.015) were independent factors for free perforation at diverticulitis onset. Free perforation occurs more frequently during the first episode of acute diverticulitis. Older patients, immunosuppressed patients and those with respiratory disease have a greater risk of presenting freely perforated diverticulitis. Therefore, it is essential to maintain a high level of clinical suspicion in these patients to activate early focus control and thus avoid fatal outcomes.
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Affiliation(s)
- María Carmona Agúndez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Badajoz, Badajoz, Spain.
| | | | - Jesús Salas Martínez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Badajoz, Badajoz, Spain
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Leonard ME, Horns JJ, Allen-Brady K, Ozanne EM, Wallace AS, Brooke BS, Supiano MA, Cohan JN. Recurrence of severe diverticulitis is associated with age and birth decade. J Gastrointest Surg 2024; 28:507-512. [PMID: 38583903 DOI: 10.1016/j.gassur.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND The risk of recurrence is an important consideration when deciding to treat patients medically or with elective colectomy after recovery from diverticulitis. It is unclear whether age is associated with recurrence. This study aimed to examine the relationship between age and the risk of recurrent diverticulitis while considering important epidemiologic factors, such as birth decade. METHODS The Utah Population Database was used to identify individuals with incident severe diverticulitis, defined as requiring an emergency department visit or hospitalization, between 1998 and 2018. This study measured the relationship between age and recurrent severe diverticulitis after adjusting for birth decade and other important variables, such as sex, urban/rural status, complicated diverticulitis, and body mass index using a Cox proportional hazards model. RESULTS The cohort included 8606 individuals with a median age of 61 years at index diverticulitis diagnosis. After adjustment, among individuals born in the same birth decade, increasing age at diverticulitis onset was associated with an increased risk of recurrent diverticulitis (hazard ratio [HR] for 10 years, 1.8; 95% CI, 1.5-2.1). Among individuals with the same age of onset, those born in a more recent birth decade were also at greater risk of recurrent diverticulitis (HR, 1.9; 95% CI, 1.6-2.3). CONCLUSION Among individuals with an index episode of severe diverticulitis, recurrence was associated with increasing age and more recent birth decade. Clinicians may wish to employ age-specific strategies when counseling patients regarding treatment options after a diverticulitis diagnosis.
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Affiliation(s)
- Molly E Leonard
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
| | - Joshua J Horns
- Department of Surgery, University of Utah, Salt Lake City, Utah, United States
| | - Kristina Allen-Brady
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Elissa M Ozanne
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Andrea S Wallace
- College of Nursing, University of Utah, Salt Lake City, Utah, United States
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
| | - Mark A Supiano
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine and University of Utah Center on Aging, Salt Lake City, Utah, United States
| | - Jessica N Cohan
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States.
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Drezdzon MK, Calata JF, Peterson CY, Otterson MF, Ludwig KA, Ridolfi TJ. Lending a hand: The utility of hand-assisted laparoscopic surgery in diverticulitis with fistula. Surgery 2024; 175:776-781. [PMID: 37867107 DOI: 10.1016/j.surg.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/10/2023] [Accepted: 08/08/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Current guidelines recommend elective colectomy for the management of diverticulitis-associated fistulas. These cases present considerable operative challenges, and surgical approaches and fistula tract management vary widely. Hand-assisted laparoscopic surgery offers the benefits of minimally invasive surgery while maintaining the tactile advantages of open surgery. This study aims to evaluate outcomes of hand-assisted laparoscopic surgery colectomy for diverticulitis-associated fistulas, fistula tract, and urinary catheter management. METHODS A retrospective review of patients with diverticulitis-associated fistula who underwent elective hand-assisted laparoscopic surgery colectomy between January 2, 2008, and September 8, 2022, was performed. Patients with Crohn disease or who underwent emergency surgery were excluded. RESULTS Seventy patients were included; the mean patient age was 64.1 ± 14.8 years, and the mean body mass index was 30.9 ± 9.1 kg/m2. Colovesical fistulas were most common (n = 48; 68.6%), followed by colovaginal fistulas (n = 22; 31.4%). The median operative time was 186 minutes. Conversion to an open approach occurred in 4 cases (5.7%). The fistula tract remnant was left without intervention in 35 patients (50%), and omental coverage occurred in 23 cases (32.9%). The median duration of the urinary catheter was 3 days (range = 1-63). There were no postoperative urine leaks. Three patients (4.3%) were readmitted in ≤30 days. There were no 30-day mortalities. CONCLUSION The challenges of colectomy for diverticulitis-associated fistulas can be mitigated using the hand-assisted laparoscopic surgery technique. We found a low conversion-to-open rate, falling below rates reported for laparoscopic colectomy. There were no cases of postoperative urine leak, suggesting that no intervention or omental coverage is a safe approach to fistula tract management.
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Affiliation(s)
| | - Jed F Calata
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Carrie Y Peterson
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Mary F Otterson
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Kirk A Ludwig
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy J Ridolfi
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
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Ferent IC, Lauro A, Rinaldi V, Frattaroli S, Varanese M, Saullo P, Caronna R. Treating a Bypass with Bypass Surgery: Repair of a Duodeno-sigmoid Fistula Complicating Acute Diverticulitis. Dig Dis Sci 2024; 69:683-688. [PMID: 38217679 DOI: 10.1007/s10620-023-08200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/16/2023] [Indexed: 01/15/2024]
Abstract
Diverticular disease is common in Western countries; one-third of patients with diverticular disease develop diverticulitis during their lifetime of whom 5% may experience serious complications. We describe a rare complication of diverticulitis: a duodeno-colic fistula in a patient with an elongated sigmoid colon (dolicosigma). The patient complained of abdominal pain, diarrhea, weight loss, and feculent vomiting. Radiological studies and gastroscopy demonstrated a fistula between the second portion of the duodenum and the sigmoid colon. Curative surgery cured the fistula and completely resolved its associated signs and symptoms.
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Affiliation(s)
| | - Augusto Lauro
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Valerio Rinaldi
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | | | - Marzia Varanese
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Paolina Saullo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Roberto Caronna
- Department of Surgery, Sapienza University of Rome, Rome, Italy
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Sabbagh C, Beyer-Berjot L, Ouaissi M, Zerbib P, Bridoux V, Manceau G, Karoui M, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Ortega-Deballon P, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiorri L, Rebibo L, Christou N, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Ahmed O, Regimbeau JM, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Giger U, Dejardin O, Pellegrin A, Alves A. Risk factors for severe morbidity and definitive stoma after elective surgery for sigmoid diverticulitis: a multicenter national cohort study. Tech Coloproctol 2024; 28:34. [PMID: 38369674 DOI: 10.1007/s10151-023-02906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/18/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level. METHODS All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD. RESULTS In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m2, and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma. CONCLUSIONS This series provides a real-life picture of elective sigmoidectomy for SDD at a national level. TRIAL REGISTRATION Comité National Information et Liberté (CNIL) (n°920361).
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France.
| | - L Beyer-Berjot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - M Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Tours, France
| | - P Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, Lille, France
| | - V Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - G Manceau
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - M Karoui
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Y Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly, France
| | - E Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - A Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - I Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - M Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - P Ortega-Deballon
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - M Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - A Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - B Menahem
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
| | - C Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - C Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - J-Y Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - B Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - C Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Y Eid
- Department of Digestive Surgery, Robert Bisson Hospital, Lisieux, France
| | - E Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Z Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - E Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - A Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | - V Defourneaux
- Department of Digestive Surgery, CHU Rennes, Rennes, France
| | - L Maggiorri
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - L Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - N Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - A Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - D Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - C Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | - A Germain
- Department of Digestive Surgery, CHRU Nancy, Nancy, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - C Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - O Ahmed
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - J-M Regimbeau
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - J Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - A Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - B Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - M Bertrand
- Department of Digestive Surgery, Universitary Hospital of Nîmes, Nîmes, France
| | - D Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - H Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - U Giger
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
| | - O Dejardin
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
- Department of Clinical Research, University Hospital of Caen, Caen, France
| | - A Pellegrin
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - A Alves
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
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Pastor-Mora JC, Fortea-Sanchís C, Coret-Franco A, García-Martínez JA, Cosa-Rodriguez R, Nomdédeu-Guinot J, Gibert-Gerez J, Laguna-Sastre M, Llueca A. Predictive risk model of recurrence of acute diverticulitis after the first episode. World J Surg 2024; 48:466-473. [PMID: 38310307 DOI: 10.1002/wjs.12045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/19/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION The recurrence of acute diverticulitis (AD) of the colon is frequent and leads to hospital readmissions and the need for elective surgery in selected cases. It is important to individualize risk factors and develop predictive tools for their identification. MATERIALS AND METHODS This prospective observational study included 368 patients who were diagnosed with AD between 2016 and 2021 in a tertiary general university hospital during their first episode and who had a good response to antibiotic, percutaneous, or peritoneal lavage treatment. Univariate and multivariate Cox regression analyses of the variables associated with recurrence were performed. Subsequently, a predictive risk score was developed and validated through survival studies. RESULTS After a median follow-up of 50 months, there were 71 (19.3%) cases of recurrence out of a total of 368 patients. The mean time of recurrence was 15 months, and 73.3% of cases of recurrence occurred before 2 years of follow-up. Recurrence was independently associated with presentation with colonic perforation in the antimesenteric location (HR 3.67 95% CI [1.59-8.4]) and a CRP level greater than 100 mg/dl (HR 1.69 95% CI [1.04-2.77). A score with 5 variables was created that differentiated two risk groups: intermediate risk (0-3 points), with 19% recurrence and high risk (more than 3 points), with 42% recurrence. CONCLUSIONS The risk of recurrence after the first episode of diverticulitis can be estimated using predictive scores. The detection of high-risk patients facilitates the individualization of follow-up and treatment.
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Affiliation(s)
- Juan Carlos Pastor-Mora
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Carlos Fortea-Sanchís
- Department of General and Digestive Surgery, Regional Hospital of Vinaròs, Castellón de la Plana, Castellón, Spain
| | - Alba Coret-Franco
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Juan Antonio García-Martínez
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Rebeca Cosa-Rodriguez
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Jesus Nomdédeu-Guinot
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Juan Gibert-Gerez
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Manuel Laguna-Sastre
- Coloproctology Unit, General and Digestive Surgery Department, Castellón General University Hospital, Castellón de la Plana, Spain
| | - Antoni Llueca
- Department of Medicine, Jaume I de Castelló University, Castellón de la Plana, Castellón, Spain
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Lauricella S, Brucchi F, Palmisano D, Baldazzi G, Bottero L, Cassini D, Faillace G. Right-sided colonic diverticulitis. Short and long-term surgical outcomes and 2-year quality of life. World J Surg 2024; 48:484-492. [PMID: 38529850 DOI: 10.1002/wjs.12065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 03/27/2024]
Abstract
AIM We aimed to investigate the short and the long-term outcomes and 2-year Quality of Life (QoL) of patients with right-sided colonic diverticulitis (RCD) surgically managed. METHOD We conducted an ambidirectional cohort study of patients with RCD undergoing surgery between 2012/2022. A colonoscopy was performed at 1-year post surgery. The enrolled patients completed the EuroQoL (EQ-5D-3L) during a regular follow-up visit at 12 and 24 months after surgery. RESULTS Three hundred nineteen patients with RCD were selected: 223 (70%) patients were treated by non-operative management (NOM) while 33 underwent surgery. Acute diverticulitis occurred in 30 patients: 9 (27.2%) were classified by CT as uncomplicated and 21 (63.6%) as complicated diverticulitis. Additionally, chronic diverticulitis occurred in 3 cases (9.2%). Specifically, 27 patients were classified by CT as 1a (81.8%) and 6 patients as 3 (18.2%). Right hemicolectomy was performed in 30 patients (90.8%), and ileo-caecectomy in 3 (9.2%). Nine (27.27%) experienced postoperative complications: 7 (77.7%) were classified according to the Clavien-Dindo as grade I-II, and 2 (22.2%) as grade III. No disease recurrence or colorectal cancer (CRC) was detected on colonoscopy. Thirty (90.8%) patients completed the 24-month follow-up. A statistically significant difference between preoperative and 24-month QoL index values (median 0.72; IQR = 0.57-0.8 vs. median 0.9; IQR = 0.82-1; p = 0.0003) was observed. CONCLUSIONS The study results demonstrate satisfactory surgical outcomes and a better QoL after surgery. No disease recurrence or CRC was observed at colonoscopy 1 year after surgery.
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Affiliation(s)
- Sara Lauricella
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
| | - Francesco Brucchi
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
- University of Milan, Milan, Italy
| | - Dario Palmisano
- University of Milano-Bicocca, Cinisello Balsamo, Milan, Italy
- General and Laparoscopic Surgery, ASST Nord Milano, Cinisello Balsamo, Milan, Italy
| | | | - Luca Bottero
- General and Laparoscopic Surgery, ASST Nord Milano, Cinisello Balsamo, Milan, Italy
| | - Diletta Cassini
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
| | - Giuseppe Faillace
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, Milan, Italy
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Cremonini C, Biloslavo A, Robustelli V, Giannessi S, Rossi Del Monte S, Mastronardi M, Musetti S, Strambi S, Coccolini F, Chiarugi M, Tartaglia D. What are the differences between the three most used classifications for acute colonic diverticulitis? A comparative multicenter study. J Trauma Acute Care Surg 2024; 96:326-331. [PMID: 37661307 DOI: 10.1097/ta.0000000000004133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Acute left-sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. Currently, the most popular classifications, based on radiological findings, are the modified Hinchey, American Association for the Surgery of Trauma (AAST), and World Society of Emergency Surgery (WSES) classifications. We hypothesize that all classifications are equivalent in predicting outcomes. METHODS This is a retrospective study of 597 patients from four medical centers between 2014 and 2021. Based on clinical, radiological, and intraoperative findings, patients were graded according to the three classifications. Regression analysis and receiver operating characteristic curve analysis were used to compare six outcomes: need for intervention, complications, major complications (Clavien-Dindo >2), reintervention, hospital length of stay, and mortality. RESULTS A total of 597 patients were included. Need for intervention, morbidity, and reintervention rates significantly increased with increasing AAST, modified Hinchey, and WSES grades. The area under the curve (AUC) for the need for intervention was 0.84 for AAST and 0.81 for modified Hinchey ( p = 0.039). The AUC for major complications was 0.75 for modified Hinchey and 0.70 for WSES ( p = 0.009). No differences were found between the three classifications when comparing AUCs for mortality, complications, and reintervention rates. CONCLUSION The AAST, WSES, and modified Hinchey classifications are similar in predicting complications, reintervention, and mortality rates. American Association for the Surgery of Trauma and modified Hinchey scores result the most adequate for predicting the need for surgery and the occurrence of major complications. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Camilla Cremonini
- From the General and Emergency Surgery Unit (C.C., S.M., S.S., F.C., M.C., D.T.), University of Pisa, Pisa, Italy; General Surgery Unit (A.B., M.M.), Cattinara University Hospital, Trieste, Italy; General Surgery Unit (V.R., S.G.), S. Jacopo Hospital, Pistoia, Italy; and General and Emergency Surgery (S.R.D.M.), San Filippo Neri Hospital, Rome, Italy
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10
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Vagios I, Vailas M, Vergadis C, Schizas D. Transverse colon diverticulitis mimicking acute appendicitis. BMJ Case Rep 2024; 17:e254703. [PMID: 38296506 PMCID: PMC10831436 DOI: 10.1136/bcr-2023-254703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
Diverticulitis in a solitary transverse colon diverticulum is uncommon, with only a handful of cases documented in the literature. There are various clinical manifestations of the disease, which make clinical and radiological diagnosis rather challenging. Herein, we present a case of a premenopausal female patient in her late 40s who presented to the emergency department, complaining of right lower quadrant abdominal pain, nausea, anorexia and fever. Following clinical, biochemical and radiological tests, the patient was prepared for surgical operation, with the presumed diagnosis of acute appendicitis. An appendicectomy was planned via a McBurney incision. Notably, no inflammation of the appendix was discovered. However, on further exploration, an inflammatory mass was identified in the transverse colon, which was subsequently excised and sent for histological examination. The histology results confirmed the presence of a ruptured solitary transverse colon diverticulum, accompanied by an adjacent mesenteric abscess. The patient's postoperative recovery was uneventful.
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Affiliation(s)
- Ilias Vagios
- 1st Surgical Department, Laiko General Hospital, Athens, Attica, Greece
| | - Michail Vailas
- 1st Surgical Department, Laiko General Hospital, Athens, Attica, Greece
| | - Chrysovalantis Vergadis
- Radiology, Division of Interventional Radiology, Laiko General Hospital, Athens, Attica, Greece
| | - Dimitrios Schizas
- 1st Surgical Department, Laiko General Hospital, Athens, Attica, Greece
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11
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Nee JW, Lembo AJ. How Would You Manage This Patient With Recurrent Diverticulitis? Ann Intern Med 2024; 177:eL230416. [PMID: 38224609 DOI: 10.7326/l23-0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Affiliation(s)
- Judy W Nee
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Anthony J Lembo
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
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12
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Fujieda T, Tanimoto T. How Would You Manage This Patient With Recurrent Diverticulitis? Ann Intern Med 2024; 177:eL230415. [PMID: 38224610 DOI: 10.7326/l23-0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Affiliation(s)
| | - Tetsuya Tanimoto
- Kitaibaraki City Hospital and Navitas Clinic Kawasaki, Kitaibaraki and Minato-ku, Japan
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13
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Gil C, Beyer-Bergeot L, Sabbagh C, Zerbib P, Bridoux V, Manceau G, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiori L, Rebibo L, Christou N, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Giger U, Alves A, Ouaissi M. Impact of the first wave of COVID-19 epidemy on the surgical management of sigmoid diverticular disease in France: National French retrospective study. Int J Colorectal Dis 2023; 38:276. [PMID: 38040936 DOI: 10.1007/s00384-023-04564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19. METHODS From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18-03/16/20), B (CR period: 03/17/20-05/03/20), and C (post CR period: 05/04/20-09/30/21). RESULTS A total of 1965 patients (A n = 1517, B n = 52, C n = 396) were included. The A group had significantly more previous SDD compared to the two other groups (p = 0.007), especially complicated (p = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) (p = 0.034 and p = 0.014). As regards surgical treatment, Hartmann's procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p = 0.034). This difference was also significant between the A and B groups (p = 0.048), as well as between the A and C groups (p = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity. CONCLUSION This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality.
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Affiliation(s)
- Camille Gil
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Avenue de la République, F37044 Tours, France
| | - Laura Beyer-Bergeot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - Charles Sabbagh
- Department of Surgery Department, Amiens University Hospital, Amiens, France
| | - Philippe Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, Lille, France
| | - Valérie Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - Gilles Manceau
- Department of digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, univeristy Paris Cité, Paris, France
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Etienne Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - Aurélien Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - Iman Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - Martin Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - Manon Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - Alexandre Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - Benjamin Menahem
- Unité INSERM UMR 1086 ANTICIPE Registre spécialisé des Tumeurs Digestives du calvados-Service de chirurgie digestive, Université de Caen Normandie 14000, Caen, France
| | - Clarisse Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - Catherine Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - Bodgan Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - Camille Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Yassine Eid
- Department of Digestive Surgery, Polyclinique de Lisieux, Lisieux, France
| | - Emilie Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - Anais Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | | | - Léon Maggiori
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - Lionel Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Niki Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - Ali Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - Cécile Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | | | - François Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - Christophe Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Sorbonne Paris Nord University, Paris, France
| | - Jean Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - Alexis Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Martin Bertrand
- Department of Digestive Surgery, Universitary Hospital of Nîmes, Nîmes, France
| | - Damien Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - Benoit Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Urs Giger
- Fliedner Fachhochschule, University of Applied Sciences, Düsseldorf, Germany
| | - Arnaud Alves
- Unité INSERM UMR 1086 ANTICIPE Registre spécialisé des Tumeurs Digestives du calvados-Service de chirurgie digestive, Université de Caen Normandie 14000, Caen, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Avenue de la République, F37044 Tours, France.
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14
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Polikarpova A, Ziaziaris WA, Manoharan V. An unusual case of perforated sigmoid diverticulitis within a large left spigelian hernia. ANZ J Surg 2023; 93:3018-3019. [PMID: 37705350 DOI: 10.1111/ans.18696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/27/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Aleksandra Polikarpova
- Hepatobiliary and Upper GI Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - William A Ziaziaris
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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15
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Lee ZL, Cooper L, Goldberg E, Curtin B, Brown RF. Benefit of Surgical Treatment for Management of Uncomplicated, Recurring Small Bowel Diverticulitis. Am Surg 2023; 89:6325-6327. [PMID: 37129121 DOI: 10.1177/00031348231173966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Zachariah L Lee
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laura Cooper
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Eric Goldberg
- Division of Gastroenterology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Bryan Curtin
- Division of Neurogastroenterology, The Institute for Digestive and Liver Disease, Mercy Medical Center, Baltimore, MD, USA
| | - Rebecca F Brown
- Department of Surgery, Section of Colon and Rectal Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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16
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Paasch C, De Santo G, Berndt N, Strik MW, Lefering R, Siegel R. Feasibility of laparoscopic resection for perforated diverticulitis: a retrospective observational study of 77 consecutive patients. Acta Chir Belg 2023; 123:632-639. [PMID: 36062887 DOI: 10.1080/00015458.2022.2122006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Perforated colonic diverticulitis with purulent or fecal contamination (PCD) is a surgical emergency with high morbidity and mortality. Traditionally, open surgery as a Hartmann procedure (HP) has been performed. Feasibility of the laparoscopic approach (LA) either with primary anastomosis (PA) or as an HP has been shown, but evidence and implementation into daily routine remain low. We analysed all patients with PCD and emergency surgery at our institution to compare post-operative outcomes between LA and open surgery. Our results should add more evidence about the potential benefit of LA in treating PCD. METHODS This retrospective analysis conducted at a tertiary care centre in Germany included all patients with PCD undergoing emergency surgery between June 2007 and February 2019. Mortality and postoperative morbidity according to Clavien-Dindo-Classification are the primary endpoints. Secondary endpoints were stoma-free survival and length of hospital stay. RESULTS Seventy-seven patients were identified (41 female/36 male; median age 67.9 years). Sixty patients underwent a LA (conversion in 9 of 60, 15%). PA has been performed in 25 of 77 patients (22 LA, 3 with open surgery). Severe complications and death (Clavien-Dindo-Classification grade IIIb-V) were lower in patients with LA (17/60, 28%) compared to open surgery (9/17, 53%; p = 0.082) as well as the length of hospital stay (LOS; LA 9 days vs. open surgery 17 days; p = 0.016). CONCLUSION The LA is feasible in the majority of patients with PCD and may be warranted as a routine in emergency surgery. Although limited by a selection bias of this retrospective study, the LA seems to reduce morbidity and LOS.
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Affiliation(s)
- Christoph Paasch
- Clinic for General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Brandenburg an der Havel, Germany
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Gianluca De Santo
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Nadja Berndt
- Medical School, Charité - University Medicine Berlin, Berlin, Germany
| | - Martin W Strik
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany
| | - Robert Siegel
- Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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17
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Bachelani AM. My thoughts: The changing role of elective colectomy for diverticular disease. Am J Surg 2023; 226:929-930. [PMID: 37479564 DOI: 10.1016/j.amjsurg.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
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Horesh N, Emile SH, Khan SM, Freund MR, Garoufalia Z, Silva-Alvarenga E, Gefen R, Wexner SD. Meta-analysis of Randomized Clinical Trials on Long-term Outcomes of Surgical Treatment of Perforated Diverticulitis. Ann Surg 2023; 278:e966-e972. [PMID: 37249187 DOI: 10.1097/sla.0000000000005909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess long-term outcomes of patients with perforated diverticulitis treated with resection or laparoscopic lavage (LL). BACKGROUND Surgical treatment of perforated diverticulitis has changed in the last few decades. LL and increasing evidence that primary anastomosis (PRA) is feasible in certain patients have broadened surgical options. However, debate about the optimal surgical strategy lingers. METHODS PubMed, Scopus, and Web of Science were searched for randomized clinical trials (RCT) on surgical treatment of perforated diverticulitis from inception to October 2022. Long-term reports of RCT comparing surgical interventions for the treatment of perforated diverticulitis were selected. The main outcome measures were long-term ostomy, long-term complications, recurrence, and reintervention rates. RESULTS After screening 2431 studies, 5 long-term follow-up studies of RCT comprising 499 patients were included. Three studies, excluding patients with fecal peritonitis, compared LL and colonic resection, and 2 compared PRA and Hartmann procedures. LL had lower odds of long-term ostomy [odds ratio (OR) = 0.133, 95% CI: 0.278-0.579; P < 0.001] and reoperation (OR = 0.585, 95% CI: 0.365-0.937; P = 0.02) compared with colonic resection but higher odds of diverticular disease recurrence (OR = 5.8, 95% CI: 2.33-14.42; P < 0.001). Colonic resection with PRA had lower odds of long-term ostomy (OR = 0.02, 95% CI: 0.003-0.195; P < 0.001), long-term complications (OR = 0.195, 95% CI: 0.113-0.335; P < 0.001), reoperation (OR = 0.2, 95% CI: 0.108-0.384; P < 0.001), and incisional hernia (OR = 0.184, 95% CI: 0.102-0.333; P < 0.001). There was no significant difference in odds of mortality among the procedures. CONCLUSIONS Long-term follow-up of patients who underwent emergency surgery for perforated diverticulitis showed that LL had lower odds of long-term ostomy and reoperation, but more risk for disease recurrence when compared with resection in purulent peritonitis. Colonic resection with PRA had better long-term outcomes than the Hartmann procedure for fecal peritonitis.
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Affiliation(s)
- Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Tel Aviv University, Israel
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura, Egypt
| | - Sualeh Muslim Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Michael R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
- Department of General Surgery Shaare Zedek Medical Center, Hebrew University of Jerusalem, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
| | | | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
- Department of General Surgery, Hadassah Medical Organization, Hebrew University of Jerusalem, Israel
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
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Kodadek LM, Moore MS, Canner JK, Schneider EB. Diverticulitis in Older Adults: Is Cognitive Impairment Associated With Outcomes? J Surg Res 2023; 291:359-366. [PMID: 37506436 DOI: 10.1016/j.jss.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Older age is associated with increased prevalence of both diverticulitis and cognitive impairment. The association between cognitive impairment and outcomes among older adults presenting to the emergency department (ED) for diverticulitis is unknown. METHODS Adults aged ≥65 y presenting to an ED with a primary diagnosis of colonic diverticulitis were identified using the Nationwide Emergency Department Sample (2016-2019) and stratified by cognitive impairment status in this retrospective cohort study. Multivariable Poisson regression models adjusted for patient age, sex, Elixhauser Comorbidity Index, primary payer status, and presence of complicated diverticulitis quantified relative risk of a) inpatient admission, b) operative intervention, and c) in-hospital mortality comparing patients with or without a diagnosis code suggestive of cognitive impairment. RESULTS Among 683,444 older adults with an ED encounter for diverticulitis from 2016 to 2019, there were 468,226 patients with isolated colonic diverticulitis and 26,388 (5.6%) with comorbid cognitive impairment. After adjustment, the risk of inpatient admission for those with cognitive impairment was 18% higher than for those without cognitive impairment (adjusted relative risks [aRR]: 1.18, 95% confidence interval [CI]: 1.17-1.20). Those with cognitive impairment were 34% more likely to undergo colectomy than those without cognitive impairment (aRR: 1.34, 95% CI: 1.24-1.44). Older adults with cognitive impairment had a 32% greater mortality than those without cognitive impairment (aRR: 1.32, 95% CI: 1.05-1.67). CONCLUSIONS Among older adults presenting for ED care with a primary diagnosis of colonic diverticulitis, individuals with cognitive impairment had higher rates of hospitalization, operative intervention, and in-hospital mortality than those without cognitive impairment.
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Affiliation(s)
- Lisa M Kodadek
- Division of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
| | - Miranda S Moore
- Department of Surgery, Center for Health Services and Outcomes Research, Yale School of Medicine, New Haven, Connecticut
| | - Joseph K Canner
- Department of Surgery, Center for Health Services and Outcomes Research, Yale School of Medicine, New Haven, Connecticut
| | - Eric B Schneider
- Department of Surgery, Center for Health Services and Outcomes Research, Yale School of Medicine, New Haven, Connecticut
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Guerra ME, Chiu AS, Chilakamarry S, Jean R, Brandt WS, Ruangvoravat L, Davis KA. Risk Factors for the Failure of Non-operative Management Among Patients Admitted for Colonic Diverticulitis. Am Surg 2023; 89:4552-4558. [PMID: 35986004 DOI: 10.1177/00031348221121546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Diverticulitis is one of the most diagnosed gastrointestinal diseases in the country, and its incidence has risen over time, especially among younger populations, with increasing attempts at non-operative management. We elected to look at acute diverticular disease from the lens of a failure analysis, where we could estimate the hazard of requiring operative intervention based upon several clinical factors. MATERIALS AND METHODS The National Inpatient Sample (NIS) was queried between 2010 and 2015 for unplanned admissions among adults with a primary diagnosis of diverticulitis. We used a proportional hazards regression to estimate the hazard of failed non-operative management from multiple clinical covariates, measured as the number of inpatient days from admission until colonic resection. We also evaluated patients who received percutaneous drainage, to investigate whether this was associated with decreasing the failure rate of non-operative management. RESULTS A total of 830,993 discharges over the study period, of whom 83,628 (10.1%) underwent operative resection during the hospitalization, and 35,796 (4.3%) patients underwent percutaneous drainage. Half of all operations occurred by hospital day 1. Among patients treated with percutaneous drainage, 11% went on to require operative intervention. The presence of a peritoneal abscess (HR 3.20, P < .01) and sepsis (HR 4.16, P < .01) were the strongest predictors of failing non-operative management. Among the subset of patients with percutaneous drains, the mean time from admission to drain placement was 2.3 days. CONCLUSION Overall 10.1% of unplanned admissions for diverticulitis result in inpatient operative resection, most of which occurred on the day of admission. Percutaneous drainage was associated with an 11% operative rate.
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Affiliation(s)
| | - Alexander S Chiu
- Department of Surgery,University of Wisconsin--Madison, Madison, WI, USA
| | | | - Raymond Jean
- Department of Surgery, Harborview Medical Center, Seattle, WA, USA
| | - Whitney S Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Lucy Ruangvoravat
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of General Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Kimberly A Davis
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of General Surgery, Yale School of Medicine, New Haven, CT, USA
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21
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Ore AS, Allar BG, Fabrizio A, Cataldo TE, Messaris E. Trends in the Management of Non-emergent Surgery for Diverticular Disease and the Impact of Practice Parameters. Am Surg 2023; 89:4590-4597. [PMID: 36044675 DOI: 10.1177/00031348221124319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the rise in diverticular disease, the ASCRS developed practice parameters to ensure high-quality patient care. Our study aims to evaluate the impact of the 2014 practice parameters on the treatment of non-emergent left-sided diverticular disease. METHODS This is a retrospective cohort study using the ACS-National Surgical Quality Improvement Project (ACS-NSQIP). Elective sigmoid resections performed by year were evaluated and compared before and after practice parameters were published. RESULTS Overall, 46,950 patients met inclusion criteria. There was a significant decrease in the number of non-emergent operations when evaluating before and after guideline implementation (P < .001). There was a significant decrease in the number of patients younger than 50 years of age operated electively for diverticular disease (25.8% vs. 23.9%, P = .005). Adoption of minimally invasive surgery continued to increase significantly throughout the study period. CONCLUSIONS Publication of the 2014 ASCRS practice parameters is associated with a change in management of diverticular disease in the non-emergent setting.
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Affiliation(s)
- Ana Sofia Ore
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Benjamin G Allar
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas E Cataldo
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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22
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Saylors S, Schaeffer HD, Dove J, Haley J, Smelser D, Carey D, Hoffman RL. Utilization of Genetically Inferred Pedigrees in a Large Clinical Population to Study Diverticulitis. J Gastrointest Surg 2023; 27:2223-2225. [PMID: 37277677 DOI: 10.1007/s11605-023-05716-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Seth Saylors
- Division of Colorectal Surgery, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA, 17822, USA.
| | - H David Schaeffer
- Division of Colorectal Surgery, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - James Dove
- Division of Molecular and Functional Genomics, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Jeremy Haley
- Division of Molecular and Functional Genomics, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Diane Smelser
- Division of Molecular and Functional Genomics, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - David Carey
- Division of Molecular and Functional Genomics, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Rebecca L Hoffman
- Division of Colorectal Surgery, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA, 17822, USA
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23
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AlSulaim HA, Garfinkle R, Marinescu D, Morin N, Ghitulescu GA, Vasilevsky CA, Faria J, Pang A, Boutros M. Is the Hartmann's procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 2018. Surg Endosc 2023; 37:7717-7728. [PMID: 37563342 DOI: 10.1007/s00464-023-10317-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Historically, Hartmann's procedure (HP) has been the operation of choice for diverticulitis in the emergency setting. However, recent evidence has demonstrated the safety of primary anastomosis (PA) with or without diverting ileostomy. The purpose of this study was to evaluate the trends of, and factors associated with, HP compared to PA in emergency surgery for diverticulitis over 25 years. METHODS Using the National Inpatient Sample database, we identified adult patients ≥ 18 years old who underwent emergency surgery for diverticulitis (HP or PA) between 1993 and 2018 using ICD-9 and ICD-10 codes. Patients with inflammatory bowel disease, gastrointestinal cancer or who underwent elective diverticulitis surgery were excluded. Trends in HP were analyzed using multivariable linear regression, and factors associated with HP were assessed with multiple logistic regression. RESULTS Of 499,433 patients who underwent colectomy in the emergency setting for acute diverticulitis, 271,288 (54.3%) had a HP and 228,145 (45.7%) had a PA. Median age was 61 years (IQR: 50-73), 53% were women, and 70.5% were white. The proportion of HP slightly increased over the study period-HP comprised 52.6% of included cases in 1993-98 and 55.2% of cases in 2014-2018 (p = 0.017). Advanced age (reference = 18-44 years; 45-54 years: OR 1.16, 95% CI 1.10-1.22; 55-64 years: OR 1.26, 95% CI 1.20-1.33; 65-74 years: OR 1.33, 95% CI 1.25-1.42; ≥ 75 years: OR 1.51, 95% CI 1.41-1.62), complicated diverticulitis (OR 1.41, 95% CI 1.36-1.46), and severity of illness (reference = minor; moderate: OR 1.46, 95% CI 1.38-1.54; major/extreme: OR 3.43, 95% CI 3.25-3.63) were associated with increased odds of HP. CONCLUSIONS Over a 26-year period, HP has remained the most performed procedure in the emergency setting for diverticulitis. Future work should focus on knowledge translation with a possible change in practice as more randomized controlled trials provide support for PA.
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Affiliation(s)
- Hatim A AlSulaim
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Surgery, Unaizah College of Medicine, Qassim University, Unaizah, Saudi Arabia
| | - Richard Garfinkle
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Daniel Marinescu
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | | | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Julio Faria
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Allison Pang
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada.
- Department of Surgery, McGill University, Montreal, QC, Canada.
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24
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Grimsley EA, Janjua HM, Read MD, Kuo PC. COVID-Induced Alterations in Surgical Care and Outcomes in Perforated Diverticulitis. Am Surg 2023; 89:3721-3726. [PMID: 37144565 DOI: 10.1177/00031348231173935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND COVID-19 caused healthcare systems to significantly alter processes of care. Literature on the pandemic's effect on healthcare processes and resulting surgical outcomes is lacking. This study aims to determine outcomes of open colectomy in patients with perforated diverticulitis during the pandemic. METHODS Using CDC data, the highest and lowest COVID mortality rates were calculated and used to establish 9-month COVID-heavy (CH) and COVID-light (CL) timeframes, respectively. Nine-months of 2019 were assigned as pre-COVID (PC) control. Florida AHCA database was utilized for patient-level data. Primary outcomes were length of stay (LOS), morbidity, and in-hospital mortality. Stepwise regression with 10-fold cross-validation determined factors most impacting outcomes. A parallel analysis excluding COVID-positive patients was performed to differentiate COVID-infection from processes of care. RESULTS There were 3862 patients in total. COVID-positive patients had longer LOS, more intensive care unit admissions, and higher morbidity and mortality. After excluding 105 COVID-positive patients, individual outcomes were not different per timeframe. Regression showed timeframe did not affect primary outcomes. DISCUSSION Outcomes following colectomy for perforated diverticulitis were worse for COVID-positive patients. Despite increased stress on the healthcare system during the pandemic, major outcomes were unchanged for COVID-negative patients. Our results indicate that despite COVID-associated changes in processes of care, acute care surgery can still be performed in COVID-negative patients without increased mortality and minimal change in morbidity.
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Affiliation(s)
- Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Haroon M Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Meagan D Read
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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25
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Tartaglia D, Cremonini C, Annunziata E, Catena F, Sartelli M, Kirkpatrick AW, Musetti S, Strambi S, Chiarugi M, Coccolini F. Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T). Tech Coloproctol 2023; 27:747-757. [PMID: 36749438 PMCID: PMC10404182 DOI: 10.1007/s10151-023-02758-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. METHODS We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). RESULTS Data from 482 patients were analyzed-229 patients (47.5%) [M:F = 1:1; median age: 60 (24-95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26-94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p < 0.00001). In group A, severe sepsis (p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann's procedure is mainly performed in grades 1-2 (p < 0.0001). Major complications increased significantly after a Hartmann's procedure (p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002). CONCLUSIONS Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann's procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also require a longer hospital stay.
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Affiliation(s)
- Dario Tartaglia
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy.
| | - Camilla Cremonini
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
| | - Elena Annunziata
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
| | - Fausto Catena
- Department of Surgery, Bufalini" Hospital, Cesena, Italy
| | | | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Canada
| | - Serena Musetti
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
| | - Silvia Strambi
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
| | - Massimo Chiarugi
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
| | - Federico Coccolini
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, Via Paradisa, Pisa, Italy
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26
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Pansuriya S, Ekkel E, Pearl L, Hain J. Complicated Diverticulitis and Pelvic Radiation Leading to Colonic Stricture, Colorectal Fistula, and Anal Stenosis. Am Surg 2023; 89:3891-3892. [PMID: 37163698 DOI: 10.1177/00031348231175128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The purpose of this case is to highlight a rare case of sigmoid colon-to-rectum fistula. A 66-year-old man with a history of pelvic radiation and diverticulosis presented to the emergency department with a 3-week history of abdominal pain and watery diarrhea. Computed tomography (CT) imaging was significant for a sigmoid-to-rectum fistula with sigmoid stricture. The patient underwent a laparoscopic colectomy with end colostomy. Pathology revealed perforated diverticulitis. To date, there have been no cases reported in literature describing sigmoid-to-rectum fistula. In conclusion, it is important to consider the development of complex diverticular disease in patients with history of pelvic radiation.
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Affiliation(s)
| | | | - Leah Pearl
- Henry Ford Macomb, Clinton Township, MI, USA
| | - Jon Hain
- Beaumont Hospital, Troy, MI, USA
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27
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Ahmadi N, Ahmadi N, Ravindran P, Kim TJ, Byrne CM, Young CJ. Acute diverticulitis in immunosuppressed patients: a 12-year management experience. ANZ J Surg 2023; 93:2161-2165. [PMID: 37079781 DOI: 10.1111/ans.18370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Diverticular disease of the colon occurs commonly in developed countries. Immunosuppressed patients are thought to be more at risk of developing acute diverticulitis, worse disease, and higher complications secondary to therapy. This study aimed to assess outcomes for immunosuppressed patients with acute diverticulitis. METHOD A retrospective single-centre review was conducted of all patients presenting with acute diverticulitis at a major tertiary Australian hospital from 2006 to 2018. RESULT A total of 751 patients, comprising of 46 immunosuppressed patients, were included. Immunosuppressed patients were found to be older (62.25 versus 55.96, p = 0.016), have more comorbidities (median Charlson Index 3 versus 1, P < 0.001), and undergo more operative management (13.3% versus 5.1%, P = 0.020). Immunosuppressed patients with paracolic/pelvic abscesses (Modified Hinchey 1b/2) were more likely to undergo surgery (56% versus 24%, P = 0.046), while in patients with uncomplicated diverticulitis, there was no difference in immunosuppressed patients undergoing surgery (6.1% versus 5.1% P = 0.815). Immunosuppressed patients were more likely to have Grade III-IV Clavien-Dindo complication (P < 0.001). CONCLUSION Immunosuppressed patients with uncomplicated diverticulitis can be treated safely with non-operative management. Immunosuppressed patients were more likely to have operative management for Hinchey 1b/II and more likely to have grade III/IV complications.
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Affiliation(s)
- Navid Ahmadi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nima Ahmadi
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Praveen Ravindran
- Department of Colorectal Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Tae Jun Kim
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher M Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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28
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Nocera F, Haak F, Posabella A, Angehrn FV, Peterli R, Müller-Stich BP, Steinemann DC. Surgical outcomes in elective sigmoid resection for diverticulitis stratified according to indication: a propensity-score matched cohort study with 903 patients. Langenbecks Arch Surg 2023; 408:295. [PMID: 37535118 PMCID: PMC10400669 DOI: 10.1007/s00423-023-03034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Weighing the perioperative risk of elective sigmoidectomy is done regardless of the specific diverticulitis classification. The aim of this study is to evaluate surgical outcomes according to the classification grade and the indication. METHODS All patients who underwent elective colonic resection for diverticulitis during the ten-year study period were included. They were divided into two groups: relative surgery indication (RSI) and absolute surgery indication (ASI). RSI included microabscess and recurrent uncomplicated disease. ASI included macroabscess and recurrent complicated disease. Propensity score-matching (PSM, 1:1) was performed. RESULTS 585 patients fulfilled criteria for RSI and 318 patients fulfilled criteria for ASI. In the univariate analysis, RSI patients were younger (62 vs. 67.7 years, p < 0.001), had a higher physical status (ASA score 1 or 2 in 80.7% vs. 60.8%, p < 0.001), were less immunosuppressed (3.4% vs. 6.9%, p = 0.021) and suffered less often from coronary heart disease (3.8% vs. 7.2%, p = 0.025). After PSM, 318 RSI vs. 318 ASI patients were selected; baseline characteristics results were comparable. The proportion of planned laparoscopic resection was 93% in RSI versus 75% in ASI (p < 0.001), and the conversion rate to open surgery for laparoscopic resection was 5.0% and 13.8% in RSI versus ASI, respectively (p < 0.001). Major morbidity (Clavien/Dindo ≥ IIIb) occurred less frequently in RSI (3.77% vs. 10%, p = 0.003). A defunctioning stoma was formed in 0.9% and 11.0% in RSI vs ASI, respectively (p < 0.001). CONCLUSION The lower risk for postoperative morbidity, the higher chance for a laparoscopic resection and the decreased rate of stoma formation are attributed to patients with recurrent uncomplicated diverticulitis or diverticulitis including a microabscess as compared to patients with complicated diverticulitis or diverticulitis and a macroabscess, and this applies even after PSM.
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Affiliation(s)
- Fabio Nocera
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
- Departmen of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland
| | - Fabian Haak
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
- Departmen of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland
| | - Alberto Posabella
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Fiorenzo Valente Angehrn
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Ralph Peterli
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Beat P Müller-Stich
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Daniel C Steinemann
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
- Departmen of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland.
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29
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Guerra F, Coletta D. Laparoscopic Surgery for Acute Right-colon Diverticulitis: Video Vignette and Systematic Review With Meta-analysis of Current Evidence of Minimally Invasive Versus Conventional Surgery. Surg Laparosc Endosc Percutan Tech 2023; 33:428-430. [PMID: 37311024 DOI: 10.1097/sle.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/18/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Over the last decade, there has been growing diffusion of minimally invasive surgery in the setting of abdominal emergencies. However, right-colon diverticulitis is still mainly approached by conventional celiotomy. MATERIALS AND METHODS A video vignette is presented showing the details of an emergent laparoscopic right colectomy as performed to treat a 59-year-old woman who presented with clinical signs of peritonitis, and radiologic findings suggestive of acute right-colon diverticulitis complicated by perforation of the hepatic flexure and periduodenal abscess. We also aimed to evaluate the relative outcomes of laparoscopic versus conventional surgery by meta-analyzing the currently available comparative evidence on the argument. RESULTS A total of 2848 patients were included in the analysis, of which 979 patients received minimally invasive surgery and 1869 had conventional surgery. Laparoscopic surgery had a longer operating time and resulted in an abbreviated hospital stay. Overall, patients receiving laparoscopy had significantly lower morbidity than those whose surgery was undertaken by laparotomy, while there was no statistically significant difference in terms of postoperative mortality. CONCLUSIONS According to the existing literature, minimally invasive surgery improves the postoperative outcomes of patients receiving surgery for right-sided colonic diverticulitis.
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Affiliation(s)
| | - Diego Coletta
- AST Pesaro-Urbino, Ospedale San Salvatore, Pesaro, Italy
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30
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Connelly TM, Cheong JY, Lincango EP, Foley N, Duraes LC, Kessler H. Surgery for young onset diverticulitis: is it curative? Int J Colorectal Dis 2023; 38:195. [PMID: 37452913 DOI: 10.1007/s00384-023-04479-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 07/18/2023]
Abstract
PURPOSE Previously considered a disease of old age, diverticular disease is increasingly prevalent in younger populations. Guidelines on surgical resection have shifted from recommending resection for all young onset patients to an individualized approach. Therefore, we aim to determine demographics and outcomes including radiographic and surgical recurrence rates in patients < 40 years old undergoing resection for diverticular disease. METHODS A retrospective, single center study was performed. All patients ≤ 39 years undergoing operative intervention for left-sided diverticular disease between Jan 2010 and July 2017 were included. Recurrence was determined by individual review of imaging and operative reports. RESULTS Overall, 147 (n = 107/72.8% male, mean age = 34.93 ± 4.12 years) patients were included. The majority were ASA 1 or 2 (n = 41/27.9% and n = 82/55.8%). The most common surgical indication was uncomplicated diverticulitis (n = 77, 52.4%) followed by perforation (n = 26/17.7%). The majority (n = 108/73.5%) of cases were elective. Seventy-nine (57.3%) of all cases were performed laparoscopically. Primary anastomosis without diversion was the most common surgical outcome (n = 108/73.5%). Median length of stay was 5 (4, 7) days. There was no mortality. There were three (2.0%) intraoperative and 38 (25.9%) postoperative complications. The most common complication was anastomotic leak (n = 6/4.1%). The majority (n = 5) of leaks occurred after elective surgery. Two neoplastic lesions (1.3% of cohort) were found (1 adenoma with low-grade dysplasia/1 polyp cancer). Over a mean follow-up of 96 (74, 123) months, only 2 (1.3%) patients experienced a surgical or radiological recurrence. CONCLUSION Both neoplasia and recurrence after resection for diverticular disease in young onset patients are rare. Leaks after primary anastomosis even in the elective setting warrant careful consideration of a defunctioning ileostomy.
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Affiliation(s)
- Tara M Connelly
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Ju Yong Cheong
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Eddy P Lincango
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Niamh Foley
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Leonardo C Duraes
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Hermann Kessler
- Dept. of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA.
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31
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Teo NZ, Ngu JCY. Robotic reversal of open Hartmann's procedure for Hinchey 3 diverticulitis: A video vignette. Colorectal Dis 2023; 25:1564-1565. [PMID: 37317034 DOI: 10.1111/codi.16639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/23/2023] [Accepted: 04/01/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Nan Zun Teo
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
| | - James Chi-Yong Ngu
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
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Azhar N, Lambrichts D, Lange J, Yaqub S, Øresland T, Schultz J, Bemelman W, Buchwald P. Laparoscopic lavage for Hinchey III perforated diverticulitis: factors for treatment failure in two randomized clinical trials. Br J Surg 2023; 110:846-851. [PMID: 37202860 PMCID: PMC10364520 DOI: 10.1093/bjs/znad114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The Scandinavian Diverticulitis (SCANDIV) trial and the LOLA arm of the LADIES trial randomized patients with Hinchey III perforated diverticulitis to laparoscopic peritoneal lavage or sigmoid resection. The aim of this analysis was to identify risk factors for treatment failure in patients with Hinchey III perforated diverticulitis. METHODS This was a post hoc analysis of the SCANDIV trial and LOLA arm. Treatment failure was defined as morbidity requiring general anaesthesia (Clavien-Dindo grade IIIb or higher) within 90 days. Age, sex, BMI, ASA fitness grade, smoking status, previous episodes of diverticulitis, previous abdominal surgery, time to surgery, and surgical competence were all tested in univariable and multivariable logistic regression analyses using an interaction variable. RESULTS The pooled analysis included 222 patients randomized to laparoscopic lavage and primary resection (116 and 106 patients respectively). Univariable analysis found ASA grade to be associated with advanced morbidity in both groups, and the following factors in the laparoscopic lavage group: smoking, corticosteroid use, and BMI. Significant factors for laparoscopic lavage morbidity in multivariable analysis were smoking (OR 7.05, 95 per cent c.i. 2.07 to 23.98; P = 0.002) and corticosteroid use (OR 6.02, 1.54 to 23.51; P = 0.010). CONCLUSION Active smoking status and corticosteroid use were risk factors for laparoscopic lavage treatment failure (advanced morbidity) in patients with perforated diverticulitis.
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Affiliation(s)
- Najia Azhar
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Daniël Lambrichts
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Surgery, University Medical Centre Amsterdam, AMC, Amsterdam, The Netherlands
| | - Johan Lange
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sheraz Yaqub
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Tom Øresland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johannes Schultz
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Willem Bemelman
- Department of Surgery, University Medical Centre Amsterdam, AMC, Amsterdam, The Netherlands
| | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Waser A, Balaphas A, Uhe I, Toso C, Buchs NC, Ris F, Meyer J. Incidence of diverticulitis recurrence after sigmoid colectomy: a retrospective cohort study from a tertiary center and systematic review. Int J Colorectal Dis 2023; 38:157. [PMID: 37261498 PMCID: PMC10235134 DOI: 10.1007/s00384-023-04454-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Our aim was to determine the incidence of diverticulitis recurrence after sigmoid colectomy for diverticular disease. METHODS Consecutive patients who benefited from sigmoid colectomy for diverticular disease from January 2007 to June 2021 were identified based on operative codes. Recurrent episodes were identified based on hospitalization codes and reviewed. Survival analysis was performed and was reported using a Kaplan-Meier curve. Follow-up was censored for last hospital visit and diverticulitis recurrence. The systematic review of the literature was performed according to the PRISMA statement. Medline, Embase, CENTRAL, and Web of Science were searched for studies reporting on the incidence of diverticulitis after sigmoid colectomy. The review was registered into PROSPERO (CRD42021237003, 25/06/2021). RESULTS One thousand three-hundred and fifty-six patients benefited from sigmoid colectomy. Four hundred and three were excluded, leaving 953 patients for inclusion. The mean age at time of sigmoid colectomy was 64.0 + / - 14.7 years. Four hundred and fifty-eight patients (48.1%) were males. Six hundred and twenty-two sigmoid colectomies (65.3%) were performed in the elective setting and 331 (34.7%) as emergency surgery. The mean duration of follow-up was 4.8 + / - 4.1 years. During this period, 10 patients (1.1%) developed reccurent diverticulitis. Nine of these episodes were classified as Hinchey 1a, and one as Hinchey 1b. The incidence of diverticulitis recurrence (95% CI) was as follows: at 1 year: 0.37% (0.12-1.13%), at 5 years: 1.07% (0.50-2.28%), at 10 years: 2.14% (1.07-4.25%) and at 15 years: 2.14% (1.07-4.25%). Risk factors for recurrence could not be assessed by logistic regression due to the low number of incidental cases. The systematic review of the literature identified 15 observational studies reporting on the incidence of diverticulitis recurrence after sigmoid colectomy, which ranged from 0 to 15% for a follow-up period ranging between 2 months and over 10 years. CONCLUSION The incidence of diverticulitis recurrence after sigmoid colectomy is of 2.14% at 15 years, and is mostly composed of Hinchey 1a episodes. The incidences reported in the literature are heterogeneous.
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Affiliation(s)
- Alexia Waser
- Medical School, University of Geneva, Geneva, Switzerland
| | - Alexandre Balaphas
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Isabelle Uhe
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicolas C Buchs
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Ris
- Medical School, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Jeremy Meyer
- Medical School, University of Geneva, Geneva, Switzerland.
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland.
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Abet E, Bawjeski S, Planche L, Weyd B, de Kerviler B. Evaluation of a treatment pathway for the management of uncomplicated diverticulitis. J Visc Surg 2023; 160:27-32. [PMID: 35459631 DOI: 10.1016/j.jviscsurg.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Recent clinical practice recommendations have radically modified the management of colonic diverticulitis. The goal of our study was to evaluate a treatment pathway for uncomplicated diverticulitis and to analyze the outcome (patient compliance, treatment failure and complications). PATIENTS AND METHODS All patients who presented to the emergency department with the diagnosis of uncomplicated diverticulitis were prospectively included in this study. The treatment pathway included an outpatient clinical re-assessment by a gastrointestinal surgeon. In case of symptomatic treatment failure, oral antibiotics were prescribed. If developed clinical signs of severity developed, the patient was referred to the emergency department for new laboratory and imaging workup. RESULTS Eighty-seven patients were included. The mean interval before re-assessment was 2.8 days. Fifty-nine patients (67.8%) had symptomatic treatment upon discharge from the emergency department and were reassessed as outpatients by the surgical team. Patient evolution was satisfactory for 45 (76.3%); 10 (16.9%) required oral antibiotics. One (1.7%) patient developed complicated diverticulitis. Thirty-four (39.1%) patients did not comply with the current recommendations. CONCLUSION In our experience, uncomplicated diverticulitis can be treated effectively in an ambulatory setting followed by early re-assessment by a surgeon.
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Affiliation(s)
- E Abet
- Department of digestive surgery, centre hospitalier départemental de Vendée, 85000 La-Roche-sur-Yon, France.
| | - S Bawjeski
- Emergency department, centre hospitalier départemental de Vendée, 85000 La-Roche-sur-Yon, France
| | - L Planche
- Clinical research unit, centre hospitalier départemental de Vendée, 85000 La-Roche-sur-Yon, France
| | - B Weyd
- Emergency department, centre hospitalier départemental de Vendée, 85000 La-Roche-sur-Yon, France
| | - B de Kerviler
- Department of digestive surgery, centre hospitalier départemental de Vendée, 85000 La-Roche-sur-Yon, France
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Hantouli MN, Droullard DJ, Khor S, Strate LL, Lavallee DC, Flum DR, Davidson GH. Indications for surgical treatment of diverticulitis: factors that influence surgical decision-making for patients and surgeons. Br J Surg 2022; 109:1329-1330. [PMID: 36102186 PMCID: PMC10616584 DOI: 10.1093/bjs/znac321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/05/2022] [Accepted: 08/21/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Mariam N Hantouli
- Department of Surgery, University of Washington, Seattle Washington, USA
| | - David J Droullard
- Department of Surgery, University of Washington, Seattle Washington, USA
| | - Sara Khor
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
| | - Lisa L Strate
- Department of Medicine, Division of Gastroenterology, Harborview Medical Center, Seattle, Washington, USA
| | | | - Dave R Flum
- Department of Surgery, University of Washington, Seattle Washington, USA
| | - Giana H Davidson
- Department of Surgery, University of Washington, Seattle Washington, USA
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Mathilde A, Mege D, Monsinjon M, Giacca M, Panis Y. Recurrence of diverticulitis after prophylactic sigmoidectomy: an underestimated problem? Colorectal Dis 2022; 25:757-763. [PMID: 36464948 DOI: 10.1111/codi.16426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/27/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022]
Abstract
AIM Several papers have been published about the risk of recurrence after an attack of diverticulitis treated conservatively. However, very few papers have been devoted to the risk of postoperative recurrence of diverticulitis (PRD) after prophylactic sigmoidectomy (PS). The aim of this work was to report the rate of PRD after PS and to assess possible risk factors for recurrence after surgery. METHOD All consecutive patients who underwent elective laparoscopic PS for diverticulitis between 2005 and 2019 were retrospectively included. PRD was assessed. RESULTS Three hundred and sixty four patients (199 men, mean age 54 ± 13 years) were included. Among these, 26 (7%) presented with 1.7 ± 1 (range 1-4) episodes of recurrence of diverticulitis after a mean delay of 44 ± 39 months (1 month-11 years) after surgery. Patients who presented with postoperative recurrence of diverticulitis were younger (46 ± 11 vs. 55 ± 13 years, p = 0.002) and more frequently had uncomplicated diverticulitis [15/26 (58%) vs. 97/338 (29%), p = 0.002] and more than two previous episodes before PS [17/26 (65%) vs. 132/338 (39%), p = 0.009] than patients without PRD. After multivariate analysis, two independent risk factors for PRD were identified: patients with more than two episodes before PS (OR = 3.3, 95% CI = 1.2-9, p = 0.005) and age < 50 years (OR = 4.5, 95% CI = 2-11, p = 0.001). If both factors were present, recurrence reached 18% (9/51). CONCLUSION Postoperative recurrence of diverticulitis is rare (7%) after PS for diverticulitis. Some patients (i.e. those with more than two episodes before PS and/or age <50 years) could be exposed to a higher risk of recurrence (up to 18%), making prophylactic surgery questionable in these patients.
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Affiliation(s)
- Aubert Mathilde
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy and Université de Paris, France
| | - Diane Mege
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy and Université de Paris, France
| | - Marie Monsinjon
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy and Université de Paris, France
| | - Massimo Giacca
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy and Université de Paris, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, Clichy and Université de Paris, France
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Höckert S, Maldonado Valdivieso P, Jaung R, Buchwald P, Bissett I. Risk factors for readmission in patients with acute diverticulitis: a retrospective study at Auckland City Hospital. N Z Med J 2022; 135:10-18. [PMID: 36302238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIM Approximately one in five patients with acute diverticulitis (AD) will experience a recurrence. This study aimed to investigate the factors at AD admission that correlate with recurrence and test the proposed risk of recurrence-score according to Sallinen et al. method: This retrospective study followed patients for five years who were admitted with operatively or computed tomography (CT)-verified AD at Auckland City Hospital from January 2012-June 2013. Demographic, laboratory, radiological and patient-related factors at initial admission were analysed in relation to readmission with recurrent AD and to test a risk score presented by Sallinen et al. results: In the adjusted analyses, previous diagnosis of AD (OR, 7.3; 95% CI, 3.1-16.9), Māori ethnicity (OR, 5.7; 95% CI, 1.4-22.7) and complicated AD at index admission (OR, 2.5; 95% CI, 1.0-6.2), were all independent factors associated with readmission with recurrence. High-risk versus low-risk groups, according to the risk score, showed 71.4% and 18.6% recurrence rates, respectively. CONCLUSION History of diverticulitis and complicated AD are risk factors for recurrence. The finding of higher recurrence rate in Māori requires further investigation utilising appropriate research methodologies. The risk score presented by Sallinen et al. may be a useful predictor of recurrent AD.
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Affiliation(s)
- Stina Höckert
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
| | | | - Rebekah Jaung
- Department of Surgery, Auckland City Hospital, The University of Auckland, Auckland, New Zealand
| | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
| | - Ian Bissett
- Department of Surgery, Auckland City Hospital, The University of Auckland, Auckland, New Zealand
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Vaghiri S, Prassas D, Knoefel WT, Krieg A. The optimal timing of elective surgery in sigmoid diverticular disease: a meta-analysis. Langenbecks Arch Surg 2022; 407:3259-3274. [PMID: 36214867 DOI: 10.1007/s00423-022-02698-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/23/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this meta-analysis was to investigate the optimal time point of elective sigmoidectomy regarding the intraoperative and postoperative course in diverticular disease. METHODS A comprehensive literature research was conducted for studies comparing the operative outcome of early elective (EE) versus delayed elective (DE) minimally invasive sigmoidectomy in patients with acute or recurrent diverticular disease. Subsequently, data from eligible studies were extracted, qualitatively assessed, and entered into a meta-analysis. By using random effect models, the pooled hazard ratio of outcomes of interest was calculated. RESULTS Eleven observational studies with a total of 2096 patients were included (EE group n = 828, DE group n = 1268). Early elective sigmoidectomy was associated with a significantly higher conversion rate as the primary outcome in comparison to the delayed elective group (OR 2.48, 95% CI 1.5427-4.0019, p = 0.0002). Of the secondary outcomes analyzed only operative time (SMD 0.14, 95% CI 0.0020-0.2701, p = 0.0466) and time of first postoperative bowel movement (SMD 0.57, 95% CI 0.1202-1.0233, p = 0.0131) were significant in favor of the delayed elective approach. CONCLUSIONS Delayed elective sigmoid resection demonstrates benefit in terms of reduced conversion rates and shortened operative time as opposed to an early approach. Conversely, operative morbidities seem to be unaffected by the timing of surgery. However, a final and robust conclusion based on the included observational cohort studies must be cautiously made. We therefore highly advocate larger randomized controlled trials with homogenous study protocols.
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Affiliation(s)
- Sascha Vaghiri
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Dimitrios Prassas
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, Bldg. 12.46, 40225, Duesseldorf, Germany.
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Chavarrías Torija N, Asensio Gómez L, Saavedra Ambrosy J, Rubio-Pérez I. Right-sided colonic diverticulitis: management of an unusual entity. Cir Esp 2022; 100:656-657. [PMID: 35753581 DOI: 10.1016/j.cireng.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/25/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Nuria Chavarrías Torija
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain.
| | - Luis Asensio Gómez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain
| | - Jorge Saavedra Ambrosy
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain
| | - Inés Rubio-Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain
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Momah T, Patel K. Acute Cholecystitis and Diverticular Abscess Patient with COVID-19 Infection. West Afr J Med 2022; 39:982-984. [PMID: 36128899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This is a case of a 53-year-old African American woman with newly diagnosed concomitant acute cholecystitis, diverticulitis, and SARS-COV-2 infection. She underwent treatment for COVID-19 with antibiotics and supportive treatment, and on day 32 after initial symptoms presented, she had an elective laparoscopic cholecystectomy. Our patient was one of the first cases to present with acute cholecystitis and diverticulitis complicated by COVID-19, and serves as a template for surgical management of non-emergent abdominal pathologies in the midst of the COVID-19 pandemic.
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Affiliation(s)
- T Momah
- University of Mississippi Medical Center, USA
| | - K Patel
- University of Mississippi Medical Center, USA
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Abstract
OBJECTIVE This study aims to characterize the extent of geographic variation in elective sigmoid resection for diverticulitis and to identify factors associated with observed variation. INTRODUCTION National guidelines for treatment of recurrent diverticulitis fail to offer strong recommendations for or against surgical intervention. We hypothesize that healthcare market factors will be significantly associated with geographic variation in colon resection for diverticulitis, a discretionary surgical intervention. METHODS We used Center for Medicare Services 100% inpatient Limited Data Set (LDS) files from January 2013 through September 2015 to calculate an observed to expected standardized colon resection ratio for each hospital referral region (HRR). We then analyzed patient, hospital-, and market-level factors associated with variation of colectomy. For each HRR, a Herfindahl-Hirschman index, a measure of market competition, was calculated. RESULTS A total of 19,557 Medicare patients underwent an elective colon resection for diverticulitis at 2462 hospitals over the study period. Standardized colon resection ratios ranged from 0 in the Tuscaloosa HRR to 3.7 in the Royal Oak, MI HRR. Few patient factors were associated with variation, but a number of hospital factors (size, area, profit status, and critical access designation) all were associated with variation. In an analysis of market factors, increased surgeon density, and decreased market competition were associated with higher predicted rates of colon resection. CONCLUSION We observed pronounced variation (excess of 3-fold) in standardized colon resection ratios for recurrent diverticulitis. Surgeon density and hospital level factors were strongly associated with this variation and may be the main drivers of colonic resection for diverticular disease. Further investigation and stronger national guidelines are needed to optimize patient selection for colectomy.
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Affiliation(s)
- Alexander T Hawkins
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lauren R Samuels
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Timothy M Geiger
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
- GRECC, Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Matthew J Resnick
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
- Embold Health, Nashville, Tennessee
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Fugazzola P, Ceresoli M, Coccolini F, Gabrielli F, Puzziello A, Monzani F, Amato B, Sganga G, Sartelli M, Menichetti F, Puglisi GA, Tartaglia D, Carcoforo P, Avenia N, Kluger Y, Paolillo C, Zago M, Leppäniemi A, Tomasoni M, Cobianchi L, Dal Mas F, Improta M, Moore EE, Peitzman AB, Sugrue M, Agnoletti V, Fraga GP, Weber DG, Damaskos D, Abu-Zidan FM, Wani I, Kirkpatrick AW, Pikoulis M, Pararas N, Tan E, Broek RT, Maier RV, Davies RJ, Kashuk J, Shelat VG, Mefire AC, Augustin G, Magnone S, Poiasina E, De Simone B, Chiarugi M, Biffl W, Baiocchi GL, Catena F, Ansaloni L. The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly. World J Emerg Surg 2022; 17:5. [PMID: 35063008 PMCID: PMC8781436 DOI: 10.1186/s13017-022-00408-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/27/2021] [Indexed: 02/08/2023] Open
Abstract
Acute left colonic diverticulitis (ALCD) in the elderly presents with unique epidemiological features when compared with younger patients. The clinical presentation is more nuanced in the elderly population, having higher in-hospital and postoperative mortality. Furthermore, geriatric comorbidities are a risk factor for complicated diverticulitis. Finally, elderly patients have a lower risk of recurrent episodes and, in case of recurrence, a lower probability of requiring urgent surgery than younger patients. The aim of the present work is to study age-related factors that may support a unique approach to the diagnosis and treatment of this problem in the elderly when compared with the WSES guidelines for the management of acute left-sided colonic diverticulitis. During the 1° Pisa Workshop of Acute Care & Trauma Surgery held in Pisa (Italy) in September 2019, with the collaboration of the World Society of Emergency Surgery (WSES), the Italian Society of Geriatric Surgery (SICG), the Italian Hospital Surgeons Association (ACOI), the Italian Emergency Surgery and Trauma Association (SICUT), the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Surgical Pathophysiology (SIFIPAC), three panel members presented a number of statements developed for each of the four themes regarding the diagnosis and management of ALCD in older patients, formulated according to the GRADE approach, at a Consensus Conference where a panel of experts participated. The statements were subsequently debated, revised, and finally approved by the Consensus Conference attendees. The current paper is a summary report of the definitive guidelines statements on each of the following topics: diagnosis, management, surgical technique and antibiotic therapy.
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Affiliation(s)
- Paola Fugazzola
- IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy.
| | - Marco Ceresoli
- General Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Federico Coccolini
- Emergency Surgery Unit, State University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Francesco Gabrielli
- General Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Alessandro Puzziello
- Department of Surgery and Transplants, AOU San Giovanni di Dio and Ruggi d'Aragona, University of Salerno, Fisciano, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Francesco Menichetti
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Dario Tartaglia
- Emergency Surgery Unit, State University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Nicola Avenia
- Medical School, General Surgery and Surgical Specialties Unit, S. Maria University Hospital University of Perugia, Terni, Italy
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ciro Paolillo
- Emergency Room Brescia Spedali Civili General Hospital, Brescia, Italy
| | - Mauro Zago
- Department of Robotic and Emergency Surgery, Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matteo Tomasoni
- IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Lorenzo Cobianchi
- IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Francesca Dal Mas
- Department of Management, Lincoln International Business School, University of Lincoln, Lincoln, UK
| | | | - Ernest E Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO, USA
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, PA, USA
| | - Michael Sugrue
- Donegal Clinical Research Academy, Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | | | - Gustavo P Fraga
- Surgery Department, Faculdade de Ciências Médicas (FCM), Unicamp Campinas, Campinas, SP, Brazil
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Imtiaz Wani
- Department of Minimal Access and General Surgery, Government Gousia Hospital, Sringar, Kashmir, India
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attiko Hospital, MSc "Global Health-Disaster Medicine", National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Nikolaos Pararas
- General Surgery, Dr Sulaiman Al Habib/Alfaisal University, Riyadh, Saudi Arabia
| | - Edward Tan
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Richard Ten Broek
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ronald V Maier
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jeffry Kashuk
- Department of Surgery, Assia Medical Group, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Goran Augustin
- Department of Surgery, University Hospital Centre, Zagreb, Croatia
| | - Stefano Magnone
- General Surgery I, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Elia Poiasina
- General Surgery I, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Belinda De Simone
- Department of General and Metabolic Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Massimo Chiarugi
- Emergency Surgery Unit, State University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Walt Biffl
- Trauma Surgery Department, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Gian Luca Baiocchi
- Department of General Surgery, ASST Cremona, University of Brescia, Cremona, Italy
| | - Fausto Catena
- General and Emergency Surgery Department, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Luca Ansaloni
- IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
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Abstract
IMPORTANCE Diverticulitis of the colon is an increasingly prevalent disease with significant implications for patient quality of life and health system resource expenditure. Although several randomized clinical trials and meta-analyses of Hartman procedure (HP) and primary anastomosis and proximal diversion (PAPD) have found surgical equipoise, questions regarding the relative performance of these treatments when applied broadly remain. OBJECTIVE To examine use of and outcomes after urgent sigmoid colectomy with end colostomy (ie, HP) vs PAPD in management of complicated diverticulitis. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study was a multicenter, population-based examination of inpatient hospitalizations, not including long-term rehabilitation facilities, using data from the 2014 to 2017 Nationwide Readmissions Database. It was performed from November 2020 to January 2021. Included patients were adults admitted with acute diverticulitis requiring HP or PAPD within 48 hours of admission. EXPOSURES Undergoing HP vs PAPD. MAIN OUTCOMES AND MEASURES Inverse probability treatment analysis was used to compare outcomes, including index mortality, composite complications (ie, neurologic, infectious, and cardiovascular complications), length of stay, and readmissions within 90 days. RESULTS During the study period, an estimated 1 072 395 adults (615 954 [57.4%] women; median [IQR] age, 64 [52-76] years) required nonelective hospitalization for acute colonic diverticulutus. A total of 34 126 patients required diversion, with 32 326 patients (94.7%) undergoing HP and 1800 patients (5.3%) undergoing PAPD within 48 hours of admission. Patients undergoing PAPD had a decreased median (IQR) age (60 [51-70] years vs 65 [54-74] years; P < .001) and decreased rates of end organ dysfunction (520 patients [28.9%] vs 11 514 patients [35.6%]; P < .001). In inverse probability treatment weight analysis, the odds of mortality (adjusted odds ratio [aOR], 0.63; 95% CI, 0.32-1.40), complications (aOR, 0.86; 95% CI, 0.66-1.13), and nonhome discharge (aOR 1.15; 95% CI, 0.83-1.60) were similar for PAPD compared with HP. Among 1772 patients who underwent PAPD and survived index hospitalization, there was an increased incidence of 90-day readmission compared with 30 851 patients who underwent HP and survived index hospitalization (393 patients [22.2%] vs 4384 patients [14.2%]; P < .001) with increased hazard of ostomy reversal (hazard ratio, 1.46; 95% CI, 1.08-1.99). CONCLUSIONS AND RELEVANCE This study found that the use of PAPD was associated with comparable index hospitalization outcomes vs use of HP, while readmission rate and ostomy risk were statistically significantly increased among patients who underwent PAPD compared with patients who underwent HP. These findings suggest that further delineation of criteria for appropriate application of PAPD in the urgent setting are warranted.
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Affiliation(s)
- Yas Sanaiha
- Cardiac Outcomes Research Laboratory, University of California, Los Angeles
- Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Sylmara
| | - Joseph Hadaya
- Cardiac Outcomes Research Laboratory, University of California, Los Angeles
- Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Sylmara
| | - Esteban Aguayo
- Cardiac Outcomes Research Laboratory, University of California, Los Angeles
| | - Formosa Chen
- Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Sylmara
| | - Peyman Benharash
- Cardiac Outcomes Research Laboratory, University of California, Los Angeles
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Austin C, Jimenez-Rodriguez R, Yuval JB, Coleman JA, Weiser MR. Robotic colectomy and repair of colovesical fistula due to diverticulitis - a video vignette. Colorectal Dis 2021; 23:3045-3046. [PMID: 34491612 PMCID: PMC8842849 DOI: 10.1111/codi.15903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Charlotte Austin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Jonathan B Yuval
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonathan A Coleman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Cirocchi R, Nascimbeni R, Burini G, Boselli C, Barberini F, Davies J, Di Saverio S, Cassini D, Amato B, Binda GA, Bassotti G. The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review. Medicina (Kaunas) 2021; 57:medicina57101127. [PMID: 34684164 PMCID: PMC8538273 DOI: 10.3390/medicina57101127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
Abstract
Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Gloria Burini
- General & Emergency Surgical Clinic, University of Ancona, Hospital “Ospedali Riuniti di Ancona”, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-34-6570-0300
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Francesco Barberini
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Justin Davies
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Diletta Cassini
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, 20099 Milano, Italy;
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy;
| | | | - Gabrio Bassotti
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
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Abstract
CASE SUMMARY A 46-year-old man with no significant medical or surgical history presented to the emergency department with a 1-week history of worsening constipation, abdominal distension, nausea, and nonbloody, nonbilious emesis. Workup included a CT scan that was notable for a 5.3 × 3.9 cm "apple core-type" mass located within the sigmoid colon with proximal large-bowel dilation. Carcinoembryonic antigen was 1.4. No metastatic disease was seen on chest, abdominal, or pelvic CT scans. Flexible sigmoidoscopy identified a sigmoid colon mass 30 cm from the anal verge with near complete obstruction. Biopsies of the mass did not show evidence of dysplasia or malignancy. The Gastroenterology service declined to place a stent without a malignancy diagnosis. The patient subsequently underwent exploratory laparotomy, sigmoid colectomy, and end colostomy. Recovery was uneventful. Final pathology showed diverticulitis with abscess formation and no evidence of malignancy. A completion colonoscopy was unremarkable, and the patient underwent colostomy reversal 3 months later.
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Affiliation(s)
- Brian T Cain
- Division of General Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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DAMASCUS Study Management Group. Diverticulitis Management, a Snapshot Collaborative Audit Study (DAMASCUS): Protocol for an international, multicentre, prospective observational study. Colorectal Dis 2021; 23:2182-8. [PMID: 33915018 DOI: 10.1111/codi.15699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 02/08/2023]
Abstract
AIM Diverticular disease is an increasingly common problem in Western society with a variety of treatment options for those presenting with acute diverticulitis, dependent on clinical presentation. Additionally, there is significant international variability in the index management, and few published data on real-world clinical practice. The aim of DAMASCUS is to identify areas of practice variability and their potential association with differences in short- and medium-term clinical outcomes. METHODS AND ANALYSIS DAMASCUS is an international, collaborative, prospective observational study, recruiting patients from over 200 sites across six continents. The study opened in October 2020, with a rolling start. Identification of new sites ceased in February 2021 and data collection will cease in August 2021. All adult patients diagnosed with acute diverticulitis (radiologically or intra-operatively) at each participating centre will be included. The primary objective of DAMASCUS is to assess for national and international variability in the presentation and index management of acute diverticulitis (medical, interventional radiology and surgical). Secondary objectives include assessing 30-day and 6-month clinical outcome data (readmission, re-intervention, morbidity and mortality) and variations in surgical procedures for those undergoing surgery. All data will be recorded and managed using a secure REDCap electronic data capture tool and analysed using Stata (SE) version 16.1. The results will be reported in accordance with the STROBE statement. CONCLUSION By analysing variations in the management of acute diverticulitis and the subsequent outcomes, DAMASCUS will be an important step towards identifying optimal care for patients with diverticulitis.
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Dichman ML, Shabanzadeh DM. [Acute diverticulitis can be treated without antibiotics]. Ugeskr Laeger 2021; 183:V01210081. [PMID: 34356008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Diverticulitis is a complication to the common condition diverticulosis. Uncomplicated diverticulitis has traditionally been treated with antibiotics. Risk factors for diverticulitis, however, may suggest, that the condition is inflammatory rather than infectious. The evidence on antibiotic treatment for uncomplicated acute diverticulitis suggests, that antibiotics have no effect on complications, emergency surgery, recurrence, elective colonic resections and long-term complications. The evidence is based on three randomised clinical trials on the need for antibiotics, which is summarised in this review.
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Osumi W, Yamamoto M, Taniguchi K, Masubuchi S, Hamamoto H, Ishi M, Izuhara K, Tanaka K, Okuda J, Uchiyama K. Clinical experience with near-infrared ray catheter, a fluorescent ureteral catheter, on laparoscopic surgery for colon diverticulitis: A case report. Medicine (Baltimore) 2021; 100:e26085. [PMID: 34032744 PMCID: PMC8154449 DOI: 10.1097/md.0000000000026085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE As the world's population ages, the number of surgical cases of colovesical fistulas secondary to colon diverticulitis is also expected to increase. The key issue while performing laparoscopic surgery for these fistulas is the avoidance of iatrogenic ureteral injury. There are no reports of Near-infrared Ray Catheter being used in surgery for diverticulitis, which is one of the diseases with the highest risk of ureteral injury. We present a case of a male patient with colovesical fistulas secondary to sigmoid colon diverticulitis who underwent laparoscopic surgery with visualization of the ureter using a new surgical technique in laparoscopic surgery. PATIENTS CONCERN An 82-year-old man presented to our urological department with general fatigue and air and fecal matter in the urine. DIAGNOSES Cystography showed delineation of the sigmoid colon. Abdominal computed tomography findings revealed multiple sigmoid colon diverticula with thickened walls as well as large stones and a small amount of air in the bladder. He was diagnosed with a urinary tract infection with colovesical fistulas and bladder stones due to sigmoid diverticulitis. INTERVENTIONS After the creation of a transverse colostomy, we scheduled a laparoscopic anterior resection and cystolith removal. OUTCOMES Severe inflammatory adhesions around the sigmoid colon and a high risk of ureteral injury were expected preoperatively. After induction of anesthesia, we inserted a Near-infrared Ray Catheter, a fluorescent ureteral catheter, which allowed us to easily identify and visualize the ureter in real-time. This allowed bowel dissection without concerns of ureteral injury. The operative time for the gastrointestinal part of the procedure was 150 minutes, and the patient was in a good general condition after the operation and was discharged on postoperative day 7. LESSONS The course of the ureter was easily and quickly identified by the green fluorescence from the ureteral catheter during laparoscopic surgery for fistulas associated with diverticulitis, where severe inflammation and dense fibrosis were present. Our technique is an easy and feasible approach that provides real-time urethral navigation during surgery for colovesical fistulas secondary to colon diverticulitis.
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Affiliation(s)
- Wataru Osumi
- Department of General and Gastroenterological Surgery
| | | | | | | | | | | | | | | | - Junji Okuda
- Cancer Center, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
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Cirocchi R, Popivanov G, Konaktchieva M, Chipeva S, Tellan G, Mingoli A, Zago M, Chiarugi M, Binda GA, Kafka R, Anania G, Donini A, Nascimbeni R, Edilbe M, Afshar S. The role of damage control surgery in the treatment of perforated colonic diverticulitis: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:867-879. [PMID: 33089382 PMCID: PMC8026449 DOI: 10.1007/s00384-020-03784-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Damage control surgery (DCS) is the classic approach to manage severe trauma and has recently also been considered an appropriate approach to the treatment of critically ill patients with severe intra-abdominal sepsis. The purpose of the present review is to evaluate the outcomes following DCS for Hinchey II-IV complicated acute diverticulitis (CAD). METHODS A comprehensive systematic search was undertaken to identify all randomized clinical trials (RCTs) and observational studies, irrespectively of their size, publication status, and language. Adults who have undergone DCS for CAD Hinchey II, III, or IV were included in this review. DCS is compared with the immediate and definitive surgical treatment in the form of HP, colonic resection, and primary anastomosis (RPA) with or without covering stoma or laparoscopic lavage. We searched the following electronic databases: PubMed MEDLINE, Scopus, and ISI Web of Knowledge. The protocol of this systematic review and meta-analysis was published on Prospero (CRD42020144953). RESULTS Nine studies with 318 patients, undergoing DCS, were included. The presence of septic shock at the presentation in the emergency department was heterogeneous, and the weighted mean rate of septic shock across the studies was shown to be 35.1% [95% CI 8.4 to 78.6%]. The majority of the patients had Hinchey III (68.3%) disease. The remainder had either Hinchey IV (28.9%) or Hinchey II (2.8%). Phase I is similarly described in most of the studies as lavage, limited resection with closed blind colonic ends. In a few studies, resection and anastomosis (9.1%) or suture of the perforation site (0.9%) were performed in phase I of DCS. In those patients who underwent DCS, the most common method of temporary abdominal closure (TAC) was the negative pressure wound therapy (NPWT) (97.8%). The RPA was performed in 62.1% [95% CI 40.8 to 83.3%] and the 22.7% [95% CI 15.1 to 30.3%]: 12.8% during phase I and 87.2% during phase III. A covering ileostomy was performed in 6.9% [95% CI 1.5 to 12.2%]. In patients with RPA, the overall leak was 7.3% [95% CI 4.3 to 10.4%] and the major anastomotic leaks were 4.7% [95% CI 2.0 to 7.4%]; the rate of postoperative mortality was estimated to be 9.2% [95% CI 6.0 to 12.4%]. CONCLUSIONS The present meta-analysis revealed an approximately 62.1% weighted rate of achieving GI continuity with the DCS approach to generalized peritonitis in Hinchey III and IV with major leaks of 4.7% and overall mortality of 9.2%. Despite the promising results, we are aware of the limitations related to the significant heterogeneity of inclusion criteria. Importantly, the low rate of reported septic shock may point toward selection bias. Further studies are needed to evaluate the clinical advantages and cost-effectiveness of the DCS approach.
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Affiliation(s)
- Roberto Cirocchi
- Department of General Surgery, University of Perugia, 06123 Perugia, Italy
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, ul. “Sv. Georgi Sofiyski” 3, 1606 Sofia, Bulgaria
| | - Marina Konaktchieva
- Department of Gastroenterology and Hepatology, Military Medical Academy, ul. “Sv. Georgi Sofiyski” 3, 1606 Sofia, Bulgaria
| | - Sonia Chipeva
- Department of Statistics and Econometrics, University of National and World Economy, Sofia, Bulgaria
| | - Guglielmo Tellan
- Department of Emergency and Acceptance, Critical Areas and Trauma, “Umberto I” University Hospital, Sapienza University of Rome, 00161 Rome, Italy
| | - Andrea Mingoli
- Dipartimento di Chirurgia “P. Valdoni”, Sapienza Università di Roma, Viale del Policlinico155, 00161 Rome, Italy
| | - Mauro Zago
- Department of Emergency and Robotic Surgery - A.Manzoni Hospital, Lecco, Italy
| | - Massimo Chiarugi
- Emergency Surgery & Trauma Center, Cisanello University Hospital, 56124 Pisa, Italy
| | | | - Reinhold Kafka
- Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Gabriele Anania
- Department of Medical Science, University of Ferrara, 4121 Ferrara, Italy
| | - Annibale Donini
- Department of General Surgery, University of Perugia, 06123 Perugia, Italy
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy
| | - Mohammed Edilbe
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Sorena Afshar
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
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